How RPM facilitates Wake Forest’s individualized approach to weight management
When Mike Shaw was in high school, he was a three-sport athlete. Between cross-country, baseball, and basketball, he was in great shape. But that changed on a fateful day during his freshman year. While pitching a baseball game, Shaw tore his rotator cuff. The injury was so serious that it still causes him shoulder issues today. At the time, he had two options: undergo surgery, or “just kind of give up,” he explains.
“Being fearful of needles and everything else, I decided I wasn’t going to have surgery. So I just kind of gave up.”
By the time he graduated high school, Shaw was already worried about his weight, which had drastically increased following his injury. Unable to play sports, he’d lost an important outlet for physical activity and a vital part of his identity.
As life went on, so did Shaw’s weight gain. By 2019, he was a married man and a new father—two bright spots that were dulled by his increasing weight. Shaw didn’t want to suffer the same fate as his father, who succumbed to chronic preventable illness at just 52 years old, just after his son got married. Shaw wanted to be there to celebrate every milestone with his daughter—to see her graduate college, to walk her down the aisle on her wedding day.
“I was worried about ending up just like my dad, worried that I was going to have a heart attack and die,” he says. “It really wasn't until the beginning of the pandemic, when it was pretty clear that those who were morbidly obese were having more severe outcomes, that I realized the only thing in my life that I could control at that point was my own health.”
In early 2020, Shaw started taking bike rides and trying to eat less. He lost a little weight, but progress was slow. He shared his frustration with his father-in-law, and was honest about his fears of catching the coronavirus in such a vulnerable state.
His father-in-law listened closely. Then he responded with a recommendation that would change Shaw’s life. He should contact Dr. Jamy Ard and the Wake Forest Baptist Health Weight Management Center.
“It was a real heart-to-heart [between me and my father-in-law.] He pushed me, and that's when I said: ‘Okay, you know what, I'll do it’,” Shaw remembers.
For Shaw, the program was nothing short of a revelation. “Everything just started to click,” he says.
In less time than he ever thought possible, he lost a total of 110 pounds in the program.
A tailored plan
Shaw’s incredible weight loss journey is rooted in his relationship with the physician his father-in-law recommended, Jamy Ard, MD, a co-director at the Atrium Health Wake Forest Baptist Weight Management Center. During medical school at Duke University, Dr. Ard met several patients in residential weight management programs who changed the way he understood his responsibility as a physician.
“These people talked about coming into these programs with lots of medical problems, and in six weeks’ time, they're doing things that they couldn't have imagined before. It affected them from head to toe, from a psychological and mental health perspective to the physical perspective. And they changed in a dramatic way, in a very short period of time,” Dr. Ard says.
In his tenure at Wake Forest, where he’s worked since 2012, Dr. Ard oversees programs that use innovative approaches to treat obesity, all of which revolve around the same central philosophy: individualized treatment for individual patients.
Weight-loss plans are constantly updated and rewired to incorporate findings from Dr. Ard’s research into obesity and overweight treatments. They’re the product of his drive to understand how individualized plans can be optimized to prevent subsequent conditions like diabetes, hypertension, and heart disease in patients whose needs are always unique.
“Mike [Shaw] will tell you: We spent a couple hours with him in that initial appointment, as well as doing some work beforehand,” Dr. Ard says. “By the time we finished building a plan for Mike, we’d probably spent four hours or so with him to try to understand his goals and motivations, and some of the challenges that he faced in terms of managing diet and physical activity.”
After collecting as much relevant data as possible, Dr. Ard’s team builds a daily structure for each patient, including the appropriate frequency and timing of meals and the amount of physical activity the patient needs to reach their weight loss goals. There’s also a behavioral counseling component, where patients learn skills that can help them avoid emotional eating, and group classes where they engage with peers and tackle specific behavioral issues, like binge eating.
“But what we mostly do is individual, one-on-one types of engagement,” Dr. Ard says—it’s all about building relationships and trust.
Anyone is welcome to join the program. Referrals come from all over, but Dr. Ard says their biggest source of new patients is word-of-mouth.
With so many patients making incredible progress, it’s like “we’re creating walking billboards,” he says. Shaw is a perfect example. Since his weight loss, he has referred four peers to the program. One of his relatives lost 70 pounds, all while consulting with the care team virtually.
Like Shaw’s relative, patients don’t have to be local to join the program. Dr. Ard and his team serve individuals in several states, from Virginia to Tennessee. And, thanks to new tech, patients are empowered to achieve their weight loss goals virtually.
“A lot of what we do, we're able to do remotely with remote monitoring and the app,” Dr. Ard explains.
The app in question? It’s the same one that keeps Shaw abreast of his progress, structures his daily meals and activities, and connects him with team members at the Weight Management Center as often as he needs: Carium.
There’s no doubt about it, Dr. Ard says: Carium facilitates a vision for weight management that he’s been dreaming about for years.
How tech engages patients
Shaw is transparent about the fact that his weight loss journey was a team effort. Dr. Ard, for his part, is no lone wolf either. To help patients achieve better results using a comprehensive approach, he partners with a team that includes physicians, NPs, PAs, dieticians, behaviorists, and exercise physiologists.
On top of that, he’s got tech that provides the entire team with a bird’s-eye-view of every patient in their care.
“At any point in time, I can pull up Mike's profile and see what his weight was this morning, I can see what it was over the past 30 days, or since he started, and look at that trend,” Dr. Ard says.
The app helps patients log food intake, which the care team uses to track behavioral changes and offer tailored dietary feedback. For Dr. Ard, it’s all about making it easy for the patient. He can see when things are going smoothly, or when a patient might need a little extra help staying on track, like when a vacation or holiday is coming up.
For Shaw, it’s all about staying accountable. From January to May 2021, he didn’t skip tracking meals once, and logged an average of 11 food items per day in Carium.
The app’s simplicity and ease of use were fundamental to his continued engagement and overall success. Food tracking often takes place one meal at a time, but other features bring automatic benefits without the user having to stop to think about them. For example, Shaw synced his Apple Watch with the app to record his physical activity and keep track of his blood pressure, so there’s no need to input data manually.
The most pleasant surprise for Shaw was that his relationship with food was totally reformed. Between meal planning, expert consultation, and behavioral support, Dr. Ard’s program stripped away his toxic eating habits, he says, and built in their place a healthy attitude towards food and eating.
“Now I know the difference between really being hungry and just being bored and having my body trick me into thinking I'm hungry,” he says with a chuckle.
For Dr. Ard, remote patient monitoring represents a huge leap in the direction of healthy, sustainable, scalable healthcare. It could prove to be an inflection point in chronic disease management—one where patients’ accountability and access to high-quality care never fall short. And obesity treatment, he says, is where this kind of virtual care technology may have the biggest impact.
“There's nothing about your day that doesn't have an impact on your weight,” he says. “That’s why I need to be able to interact and engage with the patient as much as possible. And the evidence shows from our classic behavioral interventions, that the more often we engage the patient, the better they do.”
Shaw is no exception to this rule. Thanks to a meaningful relationship with Dr. Ard, he’s down 110 pounds. And the future—one where he's closer to achieving his dream of walking his daughter down the aisle on her wedding day—is brighter than ever.